Clexane advise? Blood clot on both lungs at 8 weeks pregnant!! HELP!!

[amjon]

Hello ladies hope you don't mind me joining in,I'm just over 8 weeks pregnant,and I'm on blood thining injections fragmin as I have factor v Leiden and I had a Dvt four years ago.This is my first baby,I don't have my appointment until 9th jan to see my consultant,just feeling really nervous about it all,one thing worrying me is how do they control the bleeding when your in labour?i know they will take u off injections before hand but was happens. If baby comes early!

Whereabouts are you located? I think that makes a huge difference in how you might be treated. In Canada the standard is to switch from low molecular weight heparin to unfractionated heparin at ~36 weeks, but that's not the case in other countries.

I'm really not all that worried about bleeding. I'm MUCH more concerned that I'm still clotting too much on the dose they have me. My MFM has said she doesn't consider FVL hetero to be any risk for clotting and really doesn't feel I should be on Lovenox, so she only agreed to keep me on the 30mg. I've had a stillborn, then 2 MC, so I'm sure it IS an issue. I'm going to ask for the anti xa test though, so hopefully they will see that I DO clot too much.

Can you supplement your Lovenox with baby Aspirin? Might add a little more peace of mind.

I do take it twice a day (even though the MFM has said once). I still don't think it's enough. I can't even get enough blood out of my finger to test my BS levels 75% of the time.

 

[Trissy]

Oh wow.. Can you get another opinion? Definitely sounds like you clot waaaaay too fast if you have trouble getting blood from your finger.

I remember when I cut my finger, nothing major, but it kept bleeding and bleeding and the doctor said that the fingers "bleed like pigs." I wasn't even on any form anti-coagulation at that point yet.

 

[amjon]

Oh wow.. Can you get another opinion? Definitely sounds like you clot waaaaay too fast if you have trouble getting blood from your finger.

I remember when I cut my finger, nothing major, but it kept bleeding and bleeding and the doctor said that the fingers "bleed like pigs." I wasn't even on any form anti-coagulation at that point yet.

I'll ask the OB to order the anti xa test and then argue from there. I made an appointment with a hematologist because I wanted it adjusted and he only did CBC and told me he thinks I'm on enough but if not we'll just up it in the next pregnancy!

 

[Trissy]

I'll ask the OB to order the anti xa test and then argue from there. I made an appointment with a hematologist because I wanted it adjusted and he only did CBC and told me he thinks I'm on enough but if not we'll just up it in the next pregnancy!

So if you're not on enough and suffer another loss THEN they'll up it for your next pregnancy?? Sheesh! That's ridiculous! The goal should be keeping your current pregnancy viable! Sometimes I think doctors forget that they're dealing with humans. Though I guess they have to or the job would destroy them, but it still really sucks for the patient.

 

[Trissy]

Hope all is well with you both!!

And the second appointment went well, that's good news been switched to the unfactionated and been induced at 39 weeks!!

Did you find out much more about epidural?

I'm at the hospital on Tuesday for my first check :-/ decided to check me at 38 week then 39 and 40

But still will not reduce my injection due to size of my clot!!

So I just hope I havnt injected!!

Hope you're both well x

How did your first check go on Tuesday??

 

[Buka345]

That to me? Trissy? If so.....

Checked cervix not ready!! But said baby is really low cudnt believe how low he was, back on Tuesday again to check to see if cervix is ready, if so I will have a stretch and sweep. Recommend lots of sex :-/ I couldn't think of anything worse haha so iv been jumping on my exercise ball haha!! I think he is going to come soon I have felt different these last two days!! Only just done my injection and iv jut come on with such a bad back ache :-/

Hope you are well x

 

[familygirl30]

Hello ladies hope you don't mind me joining in,I'm just over 8 weeks pregnant,and I'm on blood thining injections fragmin as I have factor v Leiden and I had a Dvt four years ago.This is my first baby,I don't have my appointment until 9th jan to see my consultant,just feeling really nervous about it all,one thing worrying me is how do they control the bleeding when your in labour?i know they will take u off injections before hand but was happens. If baby comes early!

Whereabouts are you located? I think that makes a huge difference in how you might be treated. In Canada the standard is to switch from low molecular weight heparin to unfractionated heparin at ~36 weeks, but that's not the case in other countries.

I'm really not all that worried about bleeding. I'm MUCH more concerned that I'm still clotting too much on the dose they have me. My MFM has said she doesn't consider FVL hetero to be any risk for clotting and really doesn't feel I should be on Lovenox, so she only agreed to keep me on the 30mg. I've had a stillborn, then 2 MC, so I'm sure it IS an issue. I'm going to ask for the anti xa test though, so hopefully they will see that I DO clot too much.

Can you supplement your Lovenox with baby Aspirin? Might add a little more peace of mind.

Sorry just replying,I'm in the uk,Im on blood thinners as I had a Dvt 4 years ago and have factor v Leiden,just be glad when I see the consultant in 4 weeks time,I'm only on a small daily dose of fragmin at the moment.

 

[Trissy]

familygirl30: Ahhh, wish I could offer some thoughts and advice but I really have no idea what the standard is in the UK and from what I've read on the forum it does seem to be different from Canada. Hopefully someone can chime in and maybe give you a better idea of what you might be in for but of course, every pregnancy is unique.

Edit: I was discussing blood thinner options with my MFM the other day because they were worried that I was having a reaction to unfractionated heparin (turns out I'm not, woohoo!) but they were saying that on low molecular weight heparin (Fragmin, Lovenox/Clexane, Innohep etc.) that you CAN have an epidural but not until at least 24 hours have passed since your last injection. Treatment-wise familygirl30, that could mean that you may stay on the Fragmin at a prevention dose for the duration of the pregnancy and then at the first sign of labour, cease injections and head to the hospital where you'll be assessed and they'll determine your care from there. And your platelet levels should be monitored regularly throughout the pregnancy. If they get too low then that is when you have to be concerned about bleeding issues in labour, but if they are monitored regularly and caught and stabilized (by switching to a different form of anticoagulation) then bleeding issues shouldn't really be an issue in labour from my understanding of things. (I'm not a doctor or nurse though, so please don't take anything as fact. I could be completely wrong about this and misunderstood my docs. )

Buka345: Almost baby time!! Cervix getting any riper??

I had my 37 week check up today, baby is fully engaged. I didn't get my cervix checked this week but it was soft last week, so I'm hoping with baby engaged and all the cramping and contractions I've been having this week that that means things are happening. My doctor doesn't think I'll make it to 40 weeks and is hoping that my sweep next Wednesday will get the show on the road!! Now I'm getting excited.. and a little anxious.

Hope all of you ladies are well and that you all have a good Christmas!!

 

[familygirl30]

familygirl30: Ahhh, wish I could offer some thoughts and advice but I really have no idea what the standard is in the UK and from what I've read on the forum it does seem to be different from Canada. Hopefully someone can chime in and maybe give you a better idea of what you might be in for but of course, every pregnancy is unique.

Edit: I was discussing blood thinner options with my MFM the other day because they were worried that I was having a reaction to unfractionated heparin (turns out I'm not, woohoo!) but they were saying that on low molecular weight heparin (Fragmin, Lovenox/Clexane, Innohep etc.) that you CAN have an epidural but not until at least 24 hours have passed since your last injection. Treatment-wise familygirl30, that could mean that you may stay on the Fragmin at a prevention dose for the duration of the pregnancy and then at the first sign of labour, cease injections and head to the hospital where you'll be assessed and they'll determine your care from there. And your platelet levels should be monitored regularly throughout the pregnancy. If they get too low then that is when you have to be concerned about bleeding issues in labour, but if they are monitored regularly and caught and stabilized (by switching to a different form of anticoagulation) then bleeding issues shouldn't really be an issue in labour from my understanding of things. (I'm not a doctor or nurse though, so please don't take anything as fact. I could be completely wrong about this and misunderstood my docs. )

Buka345: Almost baby time!! Cervix getting any riper??

I had my 37 week check up today, baby is fully engaged. I didn't get my cervix checked this week but it was soft last week, so I'm hoping with baby engaged and all the cramping and contractions I've been having this week that that means things are happening. My doctor doesn't think I'll make it to 40 weeks and is hoping that my sweep next Wednesday will get the show on the road!! Now I'm getting excited.. and a little anxious.

Hope all of you ladies are well and that you all have a good Christmas!!

Thank u so much Trissy for your advice

 

[Trissy]

Thank u so much Trissy for your advice

Hope it is helpful. Make sure to check back in after your appointment in January, I am quite interested to hear what your specialists say for your treatment!

 

[familygirl30]

Thank u so much Trissy for your advice

Hope it is helpful. Make sure to check back in after your appointment in January, I am quite interested to hear what your specialists say for your treatment!

I will let you know yes : )

 

[Trissy]

Happy new year ladies! Hope you are all doing well.

familygirl30: How was your appointment? I hope all is well with your anti-coagulation plan!

Buka345: How did your delivery go? Hope you got to enjoy some Christmas cuddles with your little boy.

I ended up being induced due to being in a car accident on December 26th. I went in for monitoring and everything seemed fine and then on the 28th I started bleeding so they started inducing me on the morning of the 29th. 26 hours later my little girl arrived.

I did end up getting two epidurals (each one with a top up) unfortunately both failed and I ended up feeling everything. Yuck! So, when on unfractionated heparin, you CAN get epidurals. The anesthetists I had both said that because I had stopped my blood thinners at least 12 hours earlier (at the time the first epidural was done it had been over 24 hours) that it was safe for me to get the epidural.

Now on prevention dose Tinzaparin but I'm still worried about clots. I will be for the rest of my life though. I'd be more comfortable with some form anti-coagulation so I may do low dose aspirin. I'm going to see if I can get a referral for a hematologist at my 6 week postpartum appointment.

 

[lunamoona]

Happy new year ladies! Hope you are all doing well.

familygirl30: How was your appointment? I hope all is well with your anti-coagulation plan!

Buka345: How did your delivery go? Hope you got to enjoy some Christmas cuddles with your little boy.

I ended up being induced due to being in a car accident on December 26th. I went in for monitoring and everything seemed fine and then on the 28th I started bleeding so they started inducing me on the morning of the 29th. 26 hours later my little girl arrived.

I did end up getting two epidurals (each one with a top up) unfortunately both failed and I ended up feeling everything. Yuck! So, when on unfractionated heparin, you CAN get epidurals. The anesthetists I had both said that because I had stopped my blood thinners at least 12 hours earlier (at the time the first epidural was done it had been over 24 hours) that it was safe for me to get the epidural.

Now on prevention dose Tinzaparin but I'm still worried about clots. I will be for the rest of my life though. I'd be more comfortable with some form anti-coagulation so I may do low dose aspirin. I'm going to see if I can get a referral for a hematologist at my 6 week postpartum appointment.

I seem to be a bit late for this thread but am in a similar position. I'm on 120mg of Clexane twice a day plus a low dose aspirin. Had a massive PE at 12 weeks, near cardiac arrest and was thrombolysed.

It's been a very anxious time as I'm sure you can all relate to but I had started to relax a bit as time has gone on.

My consultant is very nice but I don't think it occurs to him to fully explain what is going on each step of the way. This means I get little bits of information if I can read his writing or if I can think to ask the right questions. For instance, I have just recently found out that I still have some damage to my heart and that I won't be able to birth at the midwife led unit attached to the hospital. When I asked why not he said I was still very high risk....hmm...I kinda thought all the treatment I was on made me more 'normal' risk.

I can't complain about the treatment and ongoing care I have received, I have frequent scans and baby has been growing fine until this point but the fluid was a little low this week.

I guess the anxiety is building again because I now feel I've been a little naive, can't wait for all this to be over.

 

[Trissy]

I didn't embolize to the lungs this time but I understand the anxiety. I still feel it after delivering, honestly I felt it prior to being pregnant too. Once you've had a clot, that fear never really goes away.

I finally wrote down all of my questions (about my treatment, blood thinners and delivery, how long would I be allowed to labour without anti-coagulation, likelihood of clotting again, what could happen if I clotted again in my left leg, hormone changes during breastfeeding, etc.) and gave the list to my doctor and said "answer these" - I found, with the baby brain, I was always forgetting to ask my doctors questions and I was so nervous about the delivery and the weeks that followed but would constantly forget to ask the questions I needed to ask. I was very fortunate in my case that my doctor was very good about being straight forward and there were a few things she didn't know so she contacted the specialists and had the answers the next week for me.

You still have lots of time to get those answers you need and hopefully that will help lessen the anxiety of it all. (Easier said than done though, I know!)

Are you on year long treatment for your PE? Sorry to hear that there is still cardiac damage, that must be weighing heavy on your mind as well.

 

[familygirl30]

Happy new year ladies! Hope you are all doing well.

familygirl30: How was your appointment? I hope all is well with your anti-coagulation plan!

Buka345: How did your delivery go? Hope you got to enjoy some Christmas cuddles with your little boy.

I ended up being induced due to being in a car accident on December 26th. I went in for monitoring and everything seemed fine and then on the 28th I started bleeding so they started inducing me on the morning of the 29th. 26 hours later my little girl arrived.

I did end up getting two epidurals (each one with a top up) unfortunately both failed and I ended up feeling everything. Yuck! So, when on unfractionated heparin, you CAN get epidurals. The anesthetists I had both said that because I had stopped my blood thinners at least 12 hours earlier (at the time the first epidural was done it had been over 24 hours) that it was safe for me to get the epidural.

Now on prevention dose Tinzaparin but I'm still worried about clots. I will be for the rest of my life though. I'd be more comfortable with some form anti-coagulation so I may do low dose aspirin. I'm going to see if I can get a referral for a hematologist at my 6 week postpartum appointment.

Congratulations on the birth of your little girl!hope u r both well,and I'm sorry to hear about your accident!I had my first scan nearly two weeks ago and baby was sat up and not laid down haha,can't wait for my 20'week scan now!im going to be seeing my consultant the day before my next scan.So they will probably tell me a bit more hopefully x

 

[Trissy]

Haha, I love those early scans. I remember the first one I had with her at 9+2 and she was just a giant head and tiny little arms and legs and it looked like she was waving. Then at her 12+1 scan she decided she had had enough of the scan and decided to moon us and hide her face. Made for a good potty shot, though we stayed team yellow. Though she liked to hide her face the whole way through. Even at our 36+2 scan she had her feet and hands jammed up into her face so we couldn't get that one last profile shot. What a stinker, haha.

Glad to hear your scan went well. Hope you're feeling good! Not sure how the first trimester treated you but hope the second one is great.

 

[babydoodle]

I am really hoping you ladies can help me...i had a miscarriage in october at 12 weeks. After having the miscarriage, i had an appt with my rheumatologist for a foot related matter...( I have reynauds syndrome). Hearing about my miscarriage and knowing i had some bleeding problems during a past surgery (gall bladder) he sent me for some bloodwork. He did a cardiolipin panel whhich came back my cardiolipin IGA was elevated. Everything else ws normal. I do feel that i am very 'clotty' and always seem to have problems with clotting, i did after my first baby was born, the surgery, and after this miscarriage and DNC...but noone wants to put me on any aspirin or anything...my levels are 'low' I dont know what to do cause i really feel that someting about my bleeding and clotting isnt right....should i ask the rheumatologist to recheck my levels? Or if i get pregnant, will it cause abnormal levels to be higher??? ive never had any DVT or lung clotting but the elevated level concerns me...

 

[Trissy]

Very sorry for your loss.

Sounds like you should be requesting a complete thrombophilia panel to check for genetic clotting factors to begin with. Are you able to get a referral to a hematologist? Or can you seek out a hematologist on your own? That could be a good starting point for you. If thrombophilias are ruled out they may still be able to provide advice for future pregnancies.

 

[lunamoona]

I didn't embolize to the lungs this time but I understand the anxiety. I still feel it after delivering, honestly I felt it prior to being pregnant too. Once you've had a clot, that fear never really goes away.

I finally wrote down all of my questions (about my treatment, blood thinners and delivery, how long would I be allowed to labour without anti-coagulation, likelihood of clotting again, what could happen if I clotted again in my left leg, hormone changes during breastfeeding, etc.) and gave the list to my doctor and said "answer these" - I found, with the baby brain, I was always forgetting to ask my doctors questions and I was so nervous about the delivery and the weeks that followed but would constantly forget to ask the questions I needed to ask. I was very fortunate in my case that my doctor was very good about being straight forward and there were a few things she didn't know so she contacted the specialists and had the answers the next week for me.

You still have lots of time to get those answers you need and hopefully that will help lessen the anxiety of it all. (Easier said than done though, I know!)

Are you on year long treatment for your PE? Sorry to hear that there is still cardiac damage, that must be weighing heavy on your mind as well.

Thanks for your reply, I do need to think of what I need to ask before I go but I guess a lot of my questions are more me wanting reassurance that things won't go wrong which they can't really answer. At age 43 this really is my last chance to complete my family.

I'm so glad you had your LO ok despite the added challenges of a car accident, it certainly gives me hope for a good outcome for myself. The heart damage is on my mind, although it doesn't seem to affect me I'm worried the strain of labour may cause problems.

I've been very lucky, I really didn't think I was going to make it, I don't think they thought I was going to make it. I guess it's just one day at a time and trying to stay positive, no point worrying over something that is out of my hands.

Congrats again on your LO

 

[Trissy]

I didn't embolize to the lungs this time but I understand the anxiety. I still feel it after delivering, honestly I felt it prior to being pregnant too. Once you've had a clot, that fear never really goes away.

I finally wrote down all of my questions (about my treatment, blood thinners and delivery, how long would I be allowed to labour without anti-coagulation, likelihood of clotting again, what could happen if I clotted again in my left leg, hormone changes during breastfeeding, etc.) and gave the list to my doctor and said "answer these" - I found, with the baby brain, I was always forgetting to ask my doctors questions and I was so nervous about the delivery and the weeks that followed but would constantly forget to ask the questions I needed to ask. I was very fortunate in my case that my doctor was very good about being straight forward and there were a few things she didn't know so she contacted the specialists and had the answers the next week for me.

You still have lots of time to get those answers you need and hopefully that will help lessen the anxiety of it all. (Easier said than done though, I know!)

Are you on year long treatment for your PE? Sorry to hear that there is still cardiac damage, that must be weighing heavy on your mind as well.

Thanks for your reply, I do need to think of what I need to ask before I go but I guess a lot of my questions are more me wanting reassurance that things won't go wrong which they can't really answer. At age 43 this really is my last chance to complete my family.

I'm so glad you had your LO ok despite the added challenges of a car accident, it certainly gives me hope for a good outcome for myself. The heart damage is on my mind, although it doesn't seem to affect me I'm worried the strain of labour may cause problems.

I've been very lucky, I really didn't think I was going to make it, I don't think they thought I was going to make it. I guess it's just one day at a time and trying to stay positive, no point worrying over something that is out of my hands.

Congrats again on your LO

Keeping positive can do wonders but I understand the reality of how scary it can be and that some days you just can't get that fear out of your mind.

Very true, the doctors can give you statistics and scenarios but no one can say "Yes, this is exactly how it is going to play out" which can be terrifying. Hopefully you have a good support system around you to help you with the harder days, where the "what could happen" scenarios start running through your mind. Having someone to talk to about them (without having them trivialize your fears) really helped me get through my pregnancy.

How far along are you? Has your medical team come up with a delivery plan? (No worries if you're not comfortable discussing it, I know it can be a very personal decision.) Be prepared for your birth plan to go completely out the window though, mine sure did, hah! I still have a hard time talking about the actual birth as it was a long, traumatic experience, but the outcome was good and I think of that every day and am thankful. I have a healthy baby and I am healthy (although much chubbier!) so I am grateful every day.

I wish you the very, very best and hope you have a completely uneventful delivery and a healthy baby at the end.